Medifoxamine

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Medifoxamine
Medifoxamine Structural Formulae.png
Systematic (IUPAC) name
N,N-Dimethyl-2,2-diphenoxyethanamine
Clinical data
Legal status
  • ℞ (Prescription only)
Routes of
administration
Oral
Pharmacokinetic data
Bioavailability 21%[1][2]
Biological half-life 2.8 ± 1.04 hours (acute);[1][2]
4.0 hours (chronic)[3]
Identifiers
CAS Number 32359-34-5 YesY
ATC code N06AX13 (WHO)
PubChem CID: 36109
ChemSpider 33212
UNII KWU7C2A1NT YesY
KEGG D07341 YesY
Chemical data
Formula C16H19NO2
Molecular mass 257.328 g/mol
  • CN(C)CC(OC1=CC=CC=C1)OC2=CC=CC=C2
  • InChI=1S/C16H19NO2/c1-17(2)13-16(18-14-9-5-3-6-10-14)19-15-11-7-4-8-12-15/h3-12,16H,13H2,1-2H3
  • Key:QNMGHBMGNRQPNL-UHFFFAOYSA-N
  (verify)

Medifoxamine (INN) (brand names Clédial, Gerdaxyl) or medifoxamine fumarate, also known as N,N-dimethyl-2,2-diphenoxyethylamine, is an atypical[4] antidepressant with additional anxiolytic properties[5] acting via dopaminergic and serotonergic mechanisms that was formerly marketed in France and Spain, as well as Morocco.[6][7][8][9][10] The drug was first introduced in France sometime around 1990.[11] It was withdrawn from the market in 1999 (Morocco) and 2000 (France) following incidences of hepatotoxicity.[10][12][13]

Pharmacology

Medifoxamine has been found to act preferentially as a relatively weak dopamine reuptake inhibitor,[3][14][15][16] but also as an even weaker serotonin reuptake inhibitor (IC50 = 1500 nM)[3] and as a weak antagonist of the 5-HT2A and 5-HT2C receptors (IC50 = 950 and 980, respectively; notably greater affinity relative to amitriptyline and imipramine).[3][17][18] It is known to produce two active metabolites during first-pass metabolism in the liver, CRE-10086 (N-methyl-2,2-diphenoxyethylamine) and CRE-10357 (N,N-dimethyl-2-hydroxyphenoxy-2-phenoxyethylamine).[3] The IC50 values of CRE-10086 for serotonin transporter, 5-HT2A, and 5-HT2C binding are 450 nM, 330 nM, and 700 nM, respectively, while those of CRE-10357 are 660 nM, 1600 nM, and 6300 nM.[3] Medifoxamine and its metabolites lack affinity for other serotonin receptors including 5-HT1A, 5-HT1B, 5-HT1D, and 5-HT3 (>10000 nM).[3] As medifoxamine is metabolized extensively in the liver during first-pass metabolism, and as these metabolites have as much as 3-fold greater activity relative to medifoxamine, it is likely that they contribute significantly to the pharmacology of the parent drug.[3]

Efficacy and tolerability

Unlike many tricyclic antidepressants, medifoxamine lacks anticholinergic and alpha blocker properties (very low affinity for the muscarinic acetylcholine receptors and 10-fold lower affinity for the α1-adrenergic receptor relative to 5-HT2 binding sites),[3][14][19] and is also apparently inactive as a norepinephrine reuptake inhibitor (although the same source stating this also states that it is inactive as a serotonin reuptake inhibitor, which was subsequently found not to be the case).[20] Studies in mice revealed that the drug does not possess any sedative or locomotor stimulant effects.[3] In accordance with all of the preceding, medifoxamine was found to be well-tolerated at dosages of 100–300 mg per day in clinical trials.[3] Double-blind controlled clinical studies have found it to have similar effectiveness to imipramine, clomipramine, and maprotiline in the treatment of depression.[3][9][18][19]

See also

References

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